A New Interprofessional Community-Service Learning Program, HATS (Health Ambassador Teams for Seniors) to Improve Older Adults Attitudes about Telehealth and Functionality

Senior population health often is underrepresented in curricula for medical and allied health students. Furthermore, entrenched and dense curricular schedules preclude interprofessional teams from clinical experiences related to senior population health. Community service learning potentially offers the opportunity to engage interprofessional students with a panel of older adults to assess health promotion metrics over time. To test this educational concept, we created Health Ambassador Teams for Seniors, also known as HATS. Utilizing a telehealth platform, interprofessional student teams were tasked with older adult wellness promotion. The annual Medicare wellness exam served as a template for patient encounters which was enhanced with key elements of geriatric assessment such as gait and balance, cognition, and functional evaluations. The objective was to have dyads of interprofessional students conduct telehealth visits and gather healthcare data to be used for serial patient encounters and track functional trajectories over time. As a proof of concept, pilot telehealth encounters with medical, physical therapy, nursing and occupational therapy students revealed that data on older adult functional performances such as gait speed, Timed Up and Go test (TUG), and Mini-Cog test could be acquired through telehealth. Equally importantly, trainees received diverse feedback from faculty, peers and volunteer patients. A Research Electronic Data Capture (REDCap) data repository allows trainees to track patient trends relative to their health promotion recommendations as well as handoff their patient panel to the next set of trainees. The HATS program promises to strengthen the Geriatric Workforce, especially with senior population health.

Necrotizing enterocolitis in premature twins with twin-to-twin transfusion syndrome

BACKGROUND

Twin-to-twin transfusion syndrome (TTTS) is a rare but serious clinical constellation that occurs in up to 35 % of monochorionic twin pregnancies. In TTTS, transplacental vascular anastomosis results in a net transfusion from one twin to the other, leading to multiple postnatal complications. We report on two sets of immature twins with TTTS and isolated small bowel perforation with consecutive NEC.

MATERIALS AND METHODS

The gestational age of the male twins was 25 weeks and the gestational age of the female twins was 27 weeks; the mean birth weight was 560 g in the male and 780 g in the female twins. An assessment of the clinical history, including radiological and intraoperative findings and the postmortem examination is given.

RESULTS

All 4 infants developed NEC with perforation of the distal ileum. Surgical intervention was performed in all 4 children. Three of the four children died due to complications of TTTS with consecutive NEC and septicemia.

CONCLUSIONS

The most common explanation for NEC in TTTS is hypoperfusion of the gastrointestinal tract with consecutive hypoxemic damage, especially in the donor twin. In this report, a combination of immaturity and TTTS contributed to intestinal hypoperfusion and concomitant NEC. The pediatric surgeon should be aware of this complication and we recommend proactive surgical management in cases of TTTS.

Evaluation of urinary and faecal continent stomas

OBJECTIVES

To evaluate the outcome and complications of urinary and faecal continent catheterizable stomas.

PATIENTS AND METHODS

Retrospective record review of all patients operated on in our institution within the last 6 years.

RESULTS

Fifty-five children received 63 stomas. The mean age at operation was 9.2 years and the mean follow-up period was 2.8 years. The diagnoses were: neurogenic bladder (n=22), bladder or cloacal exstrophy (n=20), anorectal malformation (n=6), persistent cloaca (n=3), Hirschsprung's disease (n=2), posterior urethral valves (n=1) and prune belly syndrome (n=1). There were 35 urinary stomas and 28 faecal stomas. Eight patients received both stomas. Both the appendix and a transverse tubularized intestinal segment (Yang-Monti technique) were used; in some cases a caecal flap was created. In three patients the appendix was divided and used to construct two stomas. The implantation of urinary stomas was into the native bladder in 24 patients and into the intestinal segment of an augmented bladder in 11 cases. The location of the stoma was umbilical in 20 cases, right lower quadrant of the abdomen in 35, neo-umbilicus in five and left lower quadrant in three. When an extra-umbilical location was chosen skin flaps were used. Excellent cosmetic and functional results were achieved in 53 (84.2%) of the 63 stomas, which are continent and easy to catheterize. Two had acceptable results with minor problems. There were eight re-operations (12.6% of stomas, 14.5% of patients). The reasons for the re-operations were difficult catheterization in two, incontinence in three, and mucosal prolapse in three patients in whom skin flaps were not used. Of the eight re-operations, seven were in urinary stomas and one in a faecal stoma. Urinary incontinence was attributed to shortening of the intravesical tunnel. No difference in results was observed between the different techniques used, with the exception that cutaneous anastomosis without skin flaps had to be revised because of prolapse, and two out of three incontinent channels had been constructed with tubularized ileum.

CONCLUSIONS

Catheterizable continent urinary and faecal stomas achieve the objectives of urinary and faecal continence and independence in most patients with a low complication rate.

Self-consistent model of a positive column in a glow discharge under free-flight and collisional regimes of charged-particle motion

We consider the nonlocal theory of a positive column in a glow discharge in two cases, where the mean free path of charged particles is either greater than the discharge tube radius (the free-flight regime) or much less than the radius (the collisional regime). The great bulk of electrons, which determines the density and the discharge current in the axial direction, appears to be trapped by the radial field of a positive column. The electron flux to the wall, which compensates for the ionization in a volume, is determined by fast electrons with energies of the order of wall potential, which are able to leave in a loss cone. The electron kinetic equation, which is solved by averaging it over the radial transits for the two regimes considered, permits us to obtain the electron density and the ionization rate. Thus, we develop the theory of a positive column for the non-Boltzmann electron distribution in the radial field. Under the free-flight regime, this theory is developed by analogy with the Langmuir-Tonks one. Under the collisional regime, the spatial distribution of the potential is obtained from the ion motion equation with the ambipolar diffusion coefficient, which depends on the radial coordinate. The concrete calculations are carried out for the xenon discharge under the free-flight and collisional regimes. The theoretical calculations are compared with the results of experiments on the measurements of the electric field and the densities of metastable and resonance xenon atoms.